Publication Date

11-2024

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Abstract

Background: Terminal ileum (TI) intubation is integral to complete diagnostic ileocolonoscopy in children. It is necessary to determine terminal ileal involvement in patients with a broad spectrum of pathologic processes. In some cases the standard method of intubation does not lead to success and retroflexion is needed. Here we describe the case of terminal ileal intubation in retroflexion on a 14 year old female. Case description: 14 year-old female patient with a past medical history of chronic abdominal pain, NAFLD, anxiety, vulvovaginitis, lichen sclerosus, depression, constipation, delayed menses, and GERD who was admitted for 2 weeks of escalating symptoms and referred for endoscopy and colonoscopy to investigate potential lower intestinal etiologies. During colonoscopy, the 38 - EC 38 i10L Pentax scope was used. Intubation of terminal ileum was therefore necessary for completeness of exam but was deemed technically unfeasible after three attempts with pullback maneuver (because of inferiorly directed ileocecal valve). Ileal intubation was accomplished by careful retroflexion in the cecum with intubation upon scope withdrawal followed by advancing forward into the last 10 – 15 cms of TI. Discussion: Retroflexion for ileal intubation has been described during double balloon Enteroscopy and is useful when the ileocolic angle cannot be reduced sufficiently by pull-back of the overtube balloon or when the ileocecal valve is very backward facing. These issues with anatomy, position, and shape of the ileocecal valve are present during ileocolonoscopy as well. However, a maneuver with retroflexion is rarely used for concerns of perforation. Intubation of the terminal ileum in retroflexion has been done in adults and has been termed the Moonsault manuevar. To the best of our knowledge retroflexion for ileal intubation has not been documented in children. Conclusion: Our experience demonstrates that terminal ileal intubation in retroflexion can be done safely in the pediatric population. Assessing the outcomes of this in other similar patients will assist in determination of further guidelines of this maneuver and optimal patients for safe execution of this maneuver.

Disciplines

Gastroenterology | Pediatrics

Notes

Presented at the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN) Annual Meeting; Hollywood, FL; November 6-9, 2024.

Terminal Ileal Intubation In Retroflexion In A Pediatric Patient

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